Novel Coronavirus (COVID-19) Information for Health Professionals

Updated January 12, 2022

The City has opened five 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 Ontario Ministry of Health’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:

Testing in Pharmacies

Pharmacists conducting COVID-19 testing can refer to the following documents for information about testing and reporting results:

Health Canada has authorized Pfizer-BioNTech, Moderna, AstraZeneca, Janssen (Johnson & Johnson), and Pediatric Pfizer-BioNTech (10 mcg) COVID-19 vaccines.

Eligible individuals can receive COVID-19 vaccines, including booster doses, at City-run immunization clinics, community clinics, mobile clinics, or at participating pharmacies or primary care provider/pediatrician sites. Find more information on eligibility and booking COVID-19 vaccine appointments.

Ordering Vaccine for your Practice

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.

To learn more about providing COVID-19 vaccines in-office, see the Information for Health Professionals Providing COVID-19 Vaccines In-Office fact sheet.

Billing OHIP for Administration of COVID-19 Vaccine

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

Referrals for Viral Vector COVID-19 Vaccines

Both AstraZeneca (Vaxzevria/COVISHIELD) and Janssen (Johnson & Johnson) viral vector COVID-19 vaccine will be available at a Toronto City-run immunization clinic for those that are unable to receive mRNA vaccines (i.e., Pfizer-BioNTech or Moderna) by physician referral and by appointment only (drop-ins will not be accepted).

Eligibility criteria for referral include:

  1. The individual is 18 years of age or older.
  2. An allergist/immunologist/specialist has assessed the patient and determined that this patient has a medical contraindication (including allergy) to mRNA COVID-19 vaccine. (Ontario Ministry of Health Medical Exemptions to COVID-19 Vaccinations)
  3. A physician has consulted with the patient. This patient has declined to receive mRNA COVID-19 vaccine and would like to receive a viral vector COVID-19 vaccine. The primary care physician has explained to the patient that the National Advisory Committee on Immunization (NACI) preferentially recommends a complete series with an mRNA COVID-19 vaccine to individuals in the authorized age group without contraindications to the mRNA vaccines for all who are eligible. I have informed the patient on the risks and benefits of obtaining a viral vector COVID-19 vaccine.

Primary care providers and/or specialists can refer eligible patients using TPH’s Viral Vector COVID-19 Vaccine Referral Form.

Note: TPH will contact referred patients and arrange their appointment to receive a viral vector COVID-19 vaccine.

Second Dose Intervals for COVID-19 Vaccines

Second doses of COVID-19 vaccine can now be booked per the optimal intervals recommended by NACI:

  • Adult and Pediatric formulations of Pfizer-BioNTech and Adult formulation of Moderna: 8 weeks
  • Second doses of AstraZeneca/COVISHIELD vaccine are not available at this time.

Third Doses as Part of the Primary Series

It is recommended that moderately and severely immunocompromised individuals receive a third dose of vaccine as part of their primary series as they have demonstrated a sub-optimal immune response to a complete two-dose series.

A third dose can be given at a minimum of two months (8 weeks) after the second dose.

For the most up-to-date recommendations, including a comprehensive list of eligibility criteria see COVID-19 Third Dose Recommendations.

For more information on timing of COVID-19 vaccine, see the National Comprehensive Cancer Network’s Recommendations of the National Comprehensive Cancer Network® (NCCN®) COVID-19 Vaccination Advisory Committee.

Third Doses as Part of the Primary Series – Referral Process:

Eligible individuals may access third doses by bringing the following to their vaccine appointment:

  • Their pharmacy medication record or written prescription clearly indicating the medication

OR

  • A referral form or letter from their physician

Patients should be advised:

  • Do not bring the medications to the clinic but instead bring a pharmacy medication record or written prescription as proof. This is because some medications may be toxic to others and require special handling.
  • If you do not have a pharmacy medication record, call your pharmacy to request one.
  • If you must bring medications to the clinic, place them in a clean, see-through plastic bag and ensure the bag is closed. Health care providers who will handle the medication bag should wear “chemo-safe” gloves and avoid touching the medication containers, if possible.

To complete a referral form or letter:

  • It is expected that in most case, specialists will provide eligible moderately to severely immunocompromised patients with a completed, updated third dose patient referral form (or letter*).
  • There may be situations in which primary care providers feel comfortable making the referral/completing the updated third dose patient referral form (or letter)* for eligible patients.
  • Patients must bring their form/letter to settings administering COVID-19 vaccines
  • 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 prefer to provide the patient with a referral letter instead of completing the third dose patient referral form, please include the following information:

  • 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
    • Third 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 third doses at this time.)
    • Patient-specific concerns
      • Treatment considerations and how that may affect vaccine administration

Re-vaccination with New COVID-19 Vaccine Primary Series Post Transplant and Recipients of CAR-T-cell Therapy

It is recommended that re-vaccination with a new COVID-19 vaccine primary series be initiated post-transplantation for hematopoietic stem cell transplant (HSCT), hematopoietic cell transplants (HCT) (autologous or allogeneic), and recipients of CAR-T-cell therapy given the loss of immunity following therapy or transplant. Optimal timing for re-immunization should be determined on a case-by-case basis in consultation with the clinical team.

Third Dose as Booster Dose

Individuals born in 2003 and before are eligible for a COVID-19 booster dose at an interval of at least three months (84 days) after their second dose of vaccine. Please prioritize the administration of boosters in patients who are 60 years of age and above.

  • Beginning December 20, 2021, individuals born in 2003 and earlier will be eligible to schedule their booster dose appointment at City-run immunization clinics through Ontario’s booking portal three months (84 days) after their second dose. Individuals who booked their appointment at an interval of six months (168 days) can call the Provincial Vaccine Contact Centre at 1-833-943-3900 or use Ontario’s booking portal to re-book at the three-month (84 days) interval.
  • Individuals born in 2003 or earlier who received a second dose at least three-months (84 days) ago, may also receive their booster dose at select pharmacies, hospitals, mobile clinicsor participating primary care offices offering COVID-19 vaccines.
  • Booster dose observation periods may be shortened to 5-15 minutes for booster doses if specific conditions are met, such as past experience with both previous COVID-19 vaccine doses and other relevant conditions as outlined by NACI.

Note: See Table 2: Rationale and Options for Vaccine Type and Dose offered for COVID-19 Vaccine Booster Doses in Certain Populations in the COVID-19 Vaccine Third Dose Recommendations guidance document for specific guidance on the vaccine products and dosages that should be offered as booster doses for different individuals.

Dosage for Third Doses of COVID-19 Vaccines

  • For the Pfizer-BioNTech mRNA vaccine, a full dose (30 mcg) is recommended.
  • For the Moderna mRNA vaccine:
    • a full dose (100 mcg) is recommended for resident of long-term care homes, retirement homes or seniors in other congregate living settings, adults 50 years of age and older and all eligible immunocompromised individuals.
    • a half dose (50 mcg) is recommended for other individuals less than 70 years of age.

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.

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.

To stay up-to-date about AEFIs reported following COVID-19 vaccinations, visit the Public Health Agency of Canada’s weekly report, Reported site effects following COVID-19 vaccination in Canada, regularly.

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

Fact Sheets:

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.

Individuals with medical exemptions for COVID-19 vaccinations approved and entered into CovaxON may obtain an enhanced vaccination certificate with a QR code under Ontario’s Proof of Vaccination Policy.

Exemption forms may be submitted by secure fax to 416-338-2487. Submissions must:

  • Be on the Ministry of Health medical exemption template (letters and other submission formats will not be accepted)
  • Be submitted by an Ontario physician (MD) or registered nurse in the extended class (“Registered Nurse (Extended Class)”, “RN(EC)”, “Nurse Practitioner” or “NP”) based in Toronto
  • Comply with Ministry guidance with respect to clinical assessment and exemption types
  • Confirm the patient’s consent to collect, use and disclose their personal health information to  TPH
  • If submitting multiple patients’ exemptions, fax each request separately (cover sheet not necessary)

If there is an issue with the submission, TPH will follow up with the medical practitioner.

TPH will provide a confirmation e-mail to the submitting practitioner following entry of the medical exemption into COVaxON. Operational demands related to rising case numbers may result in significantly reduced capacity to enter medical exemptions. Given this, response time estimates are currently unavailable. Once the submission form has been processed by TPH, patients will be able to download an enhanced vaccination certificate with a QR code that indicates their exemption for use in settings requiring vaccine certificates to enter or participate.

Exemptions Due to Participation in a Clinical Trial

Exemptions due to participation in a clinical trial should be sent directly to the Ministry of Health, at covaxverification@ontario.ca, by the Principal Investigator or Study Director of the trial, and not to TPH.

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 4:30 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 4:30 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.