Updated November 14, 2022

The City has six 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.

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:

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:

If you are not providing COVID-19 vaccine in your practice, you can direct your patients to book a COVID-19 vaccine appointment at a City-run clinic using the Province’s registration system or by calling 1-833-943-3900 (TTY 1-866-797-0007). Vaccines are also available at hospital immunization clinics, pop-up clinicspharmacies and some primary care providers. more information, including supports available such as transportation and/or homebound vaccinations, visit  TPH’s COVID-19 Where to Get Vaccinated.

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) details of billing (OMA login required to access PDF) 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 non-mRNA COVID-19 Vaccines

While NACI continues to preferentially recommend the use of mRNA COVID-19 vaccines for most people due to the excellent protection they provide against severe illness and hospitalization, and their well-known safety profiles, the Novavax Nuvaxovid COVID-19 vaccine may be offered as part of a primary series or as a booster dose. Note: the booster dose recommendation is off-label.

The Ontario Ministry of Health guidance is as follows:

  • Patients 18 years of age and older with medical contraindications to mRNA vaccine are to be offered Novavax Nuvaxovid COVID-19 protein subunit vaccine first. If the patient is unable (i.e., medical contraindication) to receive Novovax Nuvaxovid COVID-19 vaccine, then they may be offered Janssen (Johnson & Johnson) COVID-19 viral vector vaccine. Note: AstraZeneca COVID-19 viral vector vaccine is no longer available in Ontario.
  • Patients 18 years of age and older who decline vaccination with mRNA may only be offered Novavax Nuvaxovid COVID-19 protein subunit vaccine. Note: Janssen (Johnson & Johnson) COVID-19 viral vector vaccine vaccine is not available for this group.

Referral Process for non-mRNA COVID-19 Vaccines in Toronto

  1. Physicians and nurse practitioners may refer patients with medical contraindications to mRNA vaccines to receive a non-mRNA COVID-19 vaccine using TPH’s non-mRNA COVID-19 Vaccine Referral Form*.

*TPH will contact referred patients and arrange their appointment to receive their vaccine.

  1. Patients who decline vaccination with mRNA COVID-19 vaccines may self-refer to receive Novavax Nuvaxovid COVID-19 protein subunit vaccine using the Toronto Public Health Appointment Booking System.

All children aged 6 months and up are now eligible to receive a COVID-19 vaccine. Children must be at least 6 months of age at the time of vaccination.

Visit the COVID-19: Vaccinate Eligibility & Doses page to learn more about first doses, second doses, booster doses, including recommendations for immunocompromised individuals and post-transplant re-vaccination.

COVID-19 Vaccine after Previous COVID-19 Infection

The Ontario Ministry of Health, in alignment with NACI, continues to recommend that COVID-19 vaccines should be offered to individuals with previous SARS-CoV-2 infection without contraindications to the vaccine. Below are suggested intervals between previous SARS-CoV-2 infection and COVID-19 vaccination:

Infection prior to completion or initiation of the primary series:

  • Individuals who are not immunocompromised & have no previous history of multisystem inflammatory syndrome in children (MIS-C) should receive the vaccine dose 2 months (56 days) after symptom onset or positive test.
  • Moderately to severely immunocompromised individuals with no previous history of MIS-C should receive the vaccine dose 1-2 months (28-56 days) after symptom onset or positive test.
  • Individuals with a previous history of MIS-C should receive the vaccine dose when clinical recovery has been achieved or ≥90 days since the onset of MIS-C, whichever is longer.

Infection after primary series:

  • For those eligible to receive a booster dose, a minimum interval of 3 months (84 days) after symptom onset or positive test (if asymptomatic) is recommended; however, a 6-month (168 day) interval may provide better immune response regardless of the product given, based on clinical discretion.

COVID-19 Vaccine Coadministration with other Vaccines

NACI recommends that for individuals 5 years and older, COVID-19 vaccines may be given simultaneously with (i.e., same day), or at any time before or after non-COVID-19 vaccines (including live and non-live vaccines). Informed consent should include a discussion of the benefits and risks given the limited data available on administration of COVID-19 vaccines at the same time as, or shortly before or after, other vaccines.

At this time, monovalent Moderna (25 mcg) COVID-19 vaccine, for ages 6 months to 5 years, as well as monovalent Pfizer-BioNTech (3 mcg) for ages 6 months to 4 years should not be given concurrently (i.e., same day) with non-COVID-19 vaccines but rather wait for a period of 14 days before or after administration of non-COVID-19 vaccines. This could prevent erroneous attribution of an adverse event to one of the vaccines.

NACI acknowledges that it may be challenging for both healthcare providers and parents if multiple visits to healthcare providers are required to administer all recommended immunizations. Concurrent administration or a shortened interval between the Moderna Spikevax (25 mcg) COVID-19 vaccine or monovalent Pfizer-BioNTech (3 mcg) and other vaccines may be warranted on an individual basis in some circumstances at the clinical discretion of the healthcare provider.

Studies to assess safety and immunogenicity of concurrent administration of COVID-19 vaccines with other vaccines are ongoing.

For more information visit:

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 side effects following COVID-19 vaccination in Canada, regularly.

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

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 8:30 a.m. to 4:30 p.m.):
  • Communicable Disease Liaison Unit (CDLU) facilities: call your CDLU liaison
  • Long-Term Care and Retirement Homes: call your LRCT Liaison
After hours (weekdays after 4:30 p.m., weekends and statutory holidays):
  • Call 3-1-1 or 416-392-CITY (2489)

Outbreak Forms and Instructions

Testing

Treatment

Please follow the Ontario Science Table Guidance: Therapeutic Management of Residents of Long-term Care Homes with COVID-19.

Treatment resources

Government of Ontario Resources

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

 

COVID-19 treatments are now available.

Individuals must have a positive COVID-19 test to receive treatment (PCR or rapid antigen test [including self-administered]). The COVID-19 medications are recommended for patients who present within five days (Paxlovid) or seven days (Remdesivir) of symptom onset.

Individuals who may be eligible for treatment and have an initial negative rapid antigen test result are strongly recommended to seek laboratory-based or rapid molecular testing as soon as possible given the short time frame for receiving therapeutics.

Who can get treatment?

Paxlovid

All patients who meet the following criteria are eligible for Paxlovid, based on clinician judgement (refer to Ontario Health’s Access to COVID-19 antiviral treatment (Paxlovid): Information for primary care providers and other health care providers caring for patients in the community for details):

  • are at higher risk of severe outcomes based on clinical assessment*, AND
  • have tested positive (PCR, rapid molecular, or rapid antigen test [including self-administered]), AND
  • are mildly ill, AND
  • present within five days of symptom onset, AND
  • do not have contraindications

*Public messaging will encourage anyone who may be at higher risk of severe outcomes (based on the criteria listed below) to seek testing and an assessment (see Ministry of Health website and screener tool). Clinicians will need to assess these patients and determine whether treatment with Paxlovid is appropriate.

Key resources for clinicians to assess eligibility for Paxlovid:

  • COVID-19 Science Advisory Table’s clinical guidelines
    • These guidelines identify populations who would benefit most from Paxlovid based on a threshold of 5% risk of hospitalization. They can be used by health care providers, along with the criteria above and clinical judgement, to inform decisions on when to prescribe.

Remdesivir

  • Remdesivir, an intravenous antiviral medication administered as a three-day course, may also be available for people at higher risk of serious illness due to COVID-19 who cannot take Paxlovid or as an alternative to Paxlovid, based on clinical assessment.

NOTE: It is recommended high-risk patients are prescribed Paxlovid; patients should only receive Remdesivir if there are drug-to-drug interactions with Paxlovid

Isolation Guidelines for Individuals with COVID-19 Symptoms Following Antiviral Treatment

  • There have been reports of “COVID-19 rebound” in some individuals who have received Paxlovid for their COVID-19 illness
  • This refers to recurrence of COVID-19 symptoms in individuals 2-8 days following completion of treatment
  • Given the limited evidence on this phenomenon thus far, it is recommended that these individuals be re-isolated using the date of rebound symptom onset. This is a precautionary measure under the presumption that the rebound in symptoms is associated with a rebound in infectiousness.

The following table summarizes the process for primary care providers to refer patients for COVID-19 therapeutics in Toronto:

Hospital Name Therapeutics Available Referral Process For Primary Care Providers For more information:
Michael Garron Hospital (MGH) Paxlovid Primary care providers should direct patients to walk-in or book an appointment for an in-person assessment at our Clinical Assessment Centre. A physician will be on site for assessment from Monday to Sunday, 11 a.m. to 6 p.m.

  • An ID NOW will be completed if required, and the patient will be assessed for COVID-19 therapeutics.

Additional notes:

  • A pharmacist will complete a medication review for drug-drug interactions (Paxlovid specific)
  • Virtual follow up care provided
Call 416-469-6858 or visit Michael Garron Hospital’s website 
North York General Hospital (NYGH) Paxlovid Primary care providers should direct eligible patients to book an appointment at the NYGH Cough Cold and COVID Test Clinic where they will be assessed to determine eligibility for COVID-19 testing, and prescribed Paxlovid if appropriate. Call 416-635-2509 or visit the North York Cough, Cold and Test Clinic.
Scarborough Health Network (SHN) Paxlovid

Remdesivir (new patients (12 years and older) can be referred 7 days a week)

Primary care providers who would like to refer eligible patients should:

  • Administer ID Now or rapid antigen test at their office in person. If confirmed positive, fill in the COVID-19 Therapeutics Referral Form and fax it to 416-281-7384. Patient will be contacted for virtual assessment and provided with appropriate treatment.
  • If COVID-19 test is required, direct the patient to book an appointment at one of our COVID-19 assessment centres, where they will be assessed and tested, and referred to our COVID-19 Therapeutics Clinic if appropriate.

Additional notes:

  • A pharmacist will complete a medication review for drug-drug interactions
  • Connection with a COVID-19 remote care monitoring program or virtual care available for follow up
Call 416-281-7442 or visit Scarborough Health Network’s website.
University Health Network (UHN) &

Women’s College Hospital (WCH)

(partnered to support the delivery of COVID-19 Therapeutics)

Paxlovid

 

Remdesivir

(new patients can be referred 7 days a week)

If your eligible patient has been assessed and you would like to refer for Remdesivir, download the UHN Remdesivir Referral Form:

  • Email the completed form to COVIDCare@uhn.ca
  • The referral will be reviewed and the clinic will follow up directly with the patient to arrange treatment.

If your COVID+ patient needs a virtual assessment for treatment:

  • Call UHN Connected Care at 437-488-1650 (Monday to Saturday, 9 a.m. to 5 p.m.,  Sunday 9 a.m. to 1 p.m.)
  • Or email COVIDCare@uhn.ca to refer the patient

If your eligible patient needs an in-person clinical assessment by a physician:

  • Call WCH COVID-19 Clinical Assessment Centre at 416-804-4083 (Monday to Friday, 8 a.m. to 5 p.m., Saturday & Sunday, 8 a.m. to 12 p.m.)
    • Have the patient’s day of symptom onset and current medications ready
    • Have the COVID PCR or RAT and eGFR results ready, if available
  • After 4 p.m., email: CCACNavigator@wchospital.ca

If you are not sure or have more questions, please contact either clinic and we will help you.

UHN Connected Care Clinic
Call: 437-488-1650 or
Email: COVIDCare@uhn.caWCH CCAC
Call: 416-804-4083 or
Email: CCACNavigator@wchospital.ca

 

Although vaccines protect most people, some immunocompromised populations may have a reduced immune response to COVID-19 vaccination. Pre-exposure COVID-19 prophylaxis (prevention) may provide some protection for these patient populations.

Patient populations that should be prioritized for Evusheld are those who are least likely to mount an adequate immune response to COVID-19 vaccination.

Eligibility

In Ontario, Evusheld can be administered to individuals with the highest risk of a severe outcome from COVID-19, including:

  • solid organ transplant recipients;
  • stem cell transplant recipients;
  • CAR-T therapy recipients; and
  • other hematologic cancer patients undergoing treatment;
  • people receiving anti-B-cell therapy (e.g., rituximab) (new as of October 2022);
  • people with significant primary immunodeficiency (new as of October 2022).

To be eligible for treatment, patients must:

  • Be at least 12 years old
  • Weigh at least 40 kg
  • Not have a current COVID-19 infection
  • Not have a recent COVID-19 exposure

Before receiving Evusheld, eligible individuals should be screened to ensure they are not currently symptomatic or known to be infected with COVID-19. Individuals should also be screened to ensure they have no recent high-risk exposure to a confirmed or probable case of COVID-19 during the close contact’s period of communicability. PCR, rapid antigen, and antibody testing are not required prior to receiving Evusheld. Refer to Ontario Health’s Information about Evusheld (Tixagevimab and Cilgavimab) Reference for health care providers who may be prescribing or administering Evusheld.

Access to Evusheld in Ontario

There are various pathways to access Evusheld available to health care providers and patients. Health care providers who may be prescribing or administering Evusheld through these pathways should review Information about Evusheld (Tixagevimab and Cilgavimab) for more information.

  • Evusheld continues to be offered through select hospital-based clinics, including cancer and transplant programs, and some clinical assessment centres. Some clinics may accept referrals from providers in the community (check with the Ontario Health regional contact below).
  • NEW Effective October 3, 2022: Evusheld can be dispensed through pharmacies
    • Physicians and nurse practitioners can prescribe the drug for pickup at a local pharmacy, with administration (i.e., injection) completed by the prescribing clinician or an appropriate health care provider. Note that prescriptions for Evusheld may not be available for pick up same-day as pharmacies are likely to place orders for Evusheld upon receipt of a prescription (1–2 day turnaround).
    • Evusheld requires refrigeration storage (2°C – 8°C) and appropriate cold chain must be maintained.
    • Pharmacies can dispense 300 mg or 600 mg doses (must be specified on the prescription).
    • All prescribers who administer Evusheld will need to obtain patient consent and file a report with their local Public Health Unit as soon as possible to allow for entry into the COVAxOn reporting system. A consent and reporting template is available here.

Questions about Evusheld should be directed to your Ontario Health regional contact:

  • Central
    • Mira Backo-Shannon (Mira.Backo-Shannon@ontariohealth.ca)
    • David Pearson (David.Pearson@ontariohealth.ca)
  • East
    • Farrah Hirji (Farrah.Hirji@ontariohealth.ca)
    • Lesley Ng (Lesley.Ng@ontariohealth.ca)
  • Toronto
    • TOTherapeutics@ontariohealth.ca

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