Resources
| August 24, 2021
Clinical Practice Guideline Summary: Recommended Drugs and Biologics in Adult Patients with COVID-19
| July 21, 2021
COVID-19 Vaccine Certificates: Key Considerations for the Ontario Context
Many jurisdictions are developing and implementing COVID-19 vaccine certificates as falsification-proof, verifiable proof of immunization in secure digital or paper-based formats.
Vaccine certificates can be used to regulate entry into discretionary settings that pose a high risk for SARS-CoV-2 transmission (e.g., indoor dining, bars, gyms, cultural and sports events).
Vaccine certificates can also be used in non-discretionary settings (e.g., schools, universities, congregate settings, and workplaces), especially in settings that require mandatory vaccination.
On a short-term basis, vaccine certificates could enable the re-opening of high-risk settings sooner and/or at increased capacity. Vaccine certificates will be of particular importance to maintain economic and societal reopening if public health measures need to be reintroduced. Some jurisdictions are also implementing vaccine certificates with the goal of incentivizing COVID-19 vaccination.
On a longer-term basis, vaccine certificates can serve as a verifiable, secure, standardized, accessible and portable records of immunization.
There is currently no scientific evidence of the direct impact of COVID-19 vaccine certificates on SARS-CoV-2 transmission or population vaccination rates, and there are important ethical, legal, accessibility, and privacy considerations concerning their development and implementation.
| July 19, 2021
School Operation for the 2021-2022 Academic Year in the Context of the COVID-19 Pandemic
In-person learning is essential for the learning and overall well-being of children and youth. Therefore, barring catastrophic circumstances, schools should remain open for in-person learning.
The level of community COVID-19 burden should inform the degree of school-based measures: the provided framework should be implemented at the regional level by public health units, considering local vaccination coverage rate and metrics of COVID-19 disease severity and to a lesser extent, SARS-CoV-2 transmission rate.
Permanent measures that support the ongoing operation of schools, irrespective of the COVID-19 pandemic, include vaccination of all eligible individuals, exclusion of sick students and staff, hand hygiene, adequate ventilation, and environmental cleaning.
Temporary measures (e.g., masking, physical distancing, cohorting) implemented in response to changes in COVID-19 disease burden should take into consideration student age, grade, and vaccination status.
Re-initiation and maintenance of extracurricular activities (e.g., music, sports, clubs) is an important component of return-to-school plans.
| July 16, 2021
Ontario’s Community-Dwelling Older Adults Who Remain Unvaccinated Against COVID-19
COVID-19 vaccination rates among community-dwelling Ontarians aged 65 years and older are lowest in neighbourhoods at highest risk of SARS-CoV-2 infection, those that have the highest material deprivation, and those that are most ethnically diverse.
Lower rates of vaccination were most pronounced among older adults who had no regular contact with a primary care physician.
Between April 26, 2021 and June 7, 2021, Ontarians aged 80 years and older had the lowest increase in first dose vaccination among all eligible older adults in Ontario, suggesting that vaccination rates in this age group may have plateaued.
Community-dwelling older adults remain at disproportionately high risk of hospitalization and death due to COVID-19, and efforts should be made to maximize vaccination in this population.
| June 23, 2021
Strategies to Support Ontarians’ Capability, Opportunity, and Motivation for COVID-19 Vaccination
As of June 12, 2021, over 7 million (more than 51%) Ontarians have been vaccinated with one dose of a COVID-19 vaccine and over 1 million (more than 12%) have received two doses.1
Most (76%) Ontarians report wanting to get a COVID-19 vaccine;2 however, getting vaccinated against COVID-19 requires more than motivation alone. A combination of capability, opportunity and motivation (key drivers of behaviour) are needed to ensure everyone who wants to get vaccinated, is able to do so.3 Of note, strategies to support these drivers of behaviour are not always available, or provided equally or consistently across Ontario.4,5
Behavioural science-informed strategies can address capability and opportunity barriers facing people who are already motivated to get vaccinated to get both doses of the COVID-19 vaccines. These strategies will be key to achieving the goal of a maximally vaccinated population. Among those with lower vaccine confidence,2 further addressing known motivation-related barriers can help support Ontarians in reaching the decision that is right for them. This includes leveraging trusted sources (such as health care professionals and community leaders) to address concerns about the speed of vaccine development and potential side effects, implementing supports to increase ease and opportunity for each dose, and employing effective communication (i.e., articulating when, where, and how) around available supports to enable capability and opportunity.
This brief is designed to complement and enhance existing vaccination rollout campaigns in Ontario. The intent is to provide behavioural science-informed insights into which strategies and policies can be leveraged to address multifaceted vaccination barriers, enabling Ontarians to get each dose. As vaccine supply continues to increase in the province, this strategy will accelerate Ontario’s race to maximize immunity and support a post-pandemic Ontario.
| June 16, 2021
Clinical Practice Guidelines Webinar: Tocilizumab
Webinar hosted by the Ontario COVID-19 Drugs & Biologics Clinical Practice Guidelines Working Group
Presenters: Laveena Munshi MD MSc, Stephanie Carlin PharmD, Beth Leung PharmD MsCI
Moderator: Brad Langford PharmD
Date: Monday, April 26, from 12:00-1:00 p.m. EST
Audience: Clinicians in all hospital settings (acute teaching, large community, small community)
Objectives:
• Summarize the data on the use of tocilizumab in patients with COVID-19
• Describe the recommended populations to receive tocilizumab
• Provide advice and considerations regarding secondary infections
• Discuss access and use of tocilizumab in the context of a shortage situation
| June 16, 2021
Clinical Practice Guidelines Webinar: Medications for Outpatients with COVID-19
Webinar hosted by the Ontario COVID-19 Science Advisory Table's Drugs & Biologics Clinical Practice Guidelines Working Group on June 15, 2021.
Presenters: Kate Miller, MD, CCFP, FCFP, Ullanda Niel, MD, CCFP, FCFP, and Sumit Raybardhan BScPhm, ACPR, MPH, BCIDP
Moderator: Brad Langford, PharmD
Objectives:
Provide evidence-based recommendations on the use of medications for managing COVID-19 in the outpatient setting. Address patient questions about the appropriate use of medications for acutely managing COVID-19.
Describe tools and resources that can be used to help support prescribing for outpatients with COVID-19.
| June 10, 2021
Update on COVID-19 Projections
| June 8, 2021
COVID-19 Vaccination for People with Disabilities
Internationally, people with disabilities have been disproportionately impacted by COVID-19, accounting for nearly 60% of COVID-19 deaths in the UK and overall higher mortality rates based on social, clinical, and demographic factors. Ontario has prioritized people with disabilities across the three phases of its COVID-19 vaccination program, but there is a difference between availability and accessibility of vaccination. Ontario’s 34 public health units are responsible for leading the local distribution and administration of COVID-19 vaccines, and their public facing websites serve as entry points for information on the accessibility of vaccination. On average, these websites contain information about 5 of 18 key accessibility features, across three domains: accessible communication, physical accessibility, and accessible social and sensory environments. Ontario needs a multi-pronged strategy to reach all people with disabilities that includes improving information about communication accessibility, physical accessibility, and social and sensory environment accessibility throughout the COVID-19 vaccination journey. Ontario’s progress on vaccinating people with disabilities needs to also be measured through enhanced data monitoring efforts.
| June 4, 2021
COVID-19 and Education Disruption in Ontario: Emerging Evidence on Impacts
The COVID-19 pandemic has led to significant education disruption in Ontario. This has included mass and localized school closures, multiple models of educational provision and gaps in support for students with disabilities. The unequal distribution of school closures and pandemic-associated hardships, particularly affecting low-income families in which racialized and Indigenous groups, newcomers and people with disabilities are overrepresented, appear to be deepening and accelerating inequities in education outcomes, wherever data have been collected. Further, there are health risks associated with closures including significant physical, mental health and safety harms for students and children. Modelling suggests long-term impacts on students’ lifetime earnings and the national economy.
There are substantial data gaps on the impact of closures on Ontario’s children. However, existing information and analysis can inform strategies to minimize further pandemic disruptions to children’s education and development. Identifying or tracking areas where students are facing the greatest challenges in the wake of COVID-19 and implementing systematic supports to address pandemic-associated educational harms are critical to minimizing the overall impact and supporting recovery.
| May 31, 2021
Lessons Learned from Israel’s Reopening During a Nationwide COVID-19 Vaccination Campaign
Israel maintained an overall decrease in SARS-CoV-2 cases and COVID-19 hospitalizations, ICU admissions, and deaths throughout all phases of reopening.
Key elements of Israel’s reopening included a high proportion of adults receiving 2 doses of Pfizer-BioNTech’s COVID-19 mRNA vaccine, a phased approach prioritizing the reopening of outdoor activities and schools first, and a ‘Green Pass’ or vaccination certificate allowing fully vaccinated or COVID-19 recovered individuals to enter higher SARS-CoV-2 transmission risk settings.
| May 28, 2021
Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic
The rationale for restrictive “no visitor” policies adopted during the first wave of the COVID-19 pandemic was to limit the introduction of SARS-CoV-2 into the hospitals and to minimize the risk of transmission to the community. Available research demonstrates that (1) general hospital visitors need to be distinguished from “family/essential caregivers”, (2) family/essential caregivers do not play a substantial role in the transmission of SARS-CoV-2 in a hospital setting with infection and prevention control (IPAC) measures, and (3) blanket restrictive visitor policies are associated with potential harms particularly across specific populations.
Visitor policies which are typically established locally by each hospital must balance the potential infection risk associated with having family/essential caregivers in the hospital against the risk to specific patient populations and the resultant increase in workload to health care providers in the absence of family/essential caregivers. While creative electronic mechanisms to enhance communication between patients, their families, and the health care team were rapidly adopted, more research is needed to ensure these adaptations are culturally appropriate and equitable.
| May 28, 2021
Ivermectin to Prevent Disseminated Strongyloides Infection in Patients with COVID-19
Ivermectin, an antiparasitic agent, is currently not recommended for prophylaxis or treatment of COVID-19. Inappropriate use of ivermectin for COVID-19 may make it unavailable for patients who could benefit from its use (i.e., patients with serious parasitic infections) and reduce the already limited supply of ivermectin in Canada.
However, patients with COVID-19 who receive immunomodulatory therapies (e.g., corticosteroids including dexamethasone, interleukin-6 inhibitors including tocilizumab) may be at risk of dissemination/hyperinfection syndrome from Strongyloides stercoralis, which can be fatal.
We have developed a strategy to safely manage strongyloidiasis risk and infection in the setting of ivermectin shortage. Patients admitted to hospital with COVID-19 and at high epidemiologic risk for strongyloidiasis should be screened with serology. If a patient’s strongyloides serology is reactive or indeterminate, these patients should receive ivermectin to avoid the potential for parasitic dissemination/hyperinfection.
| May 20, 2021
Update on COVID-19 Projections
| May 19, 2021
Excess Mortality in Ontario During the COVID-19 Pandemic
Based on Ontario cremation data, there has been a 12.8% increase in the number of deaths during the COVID-19 pandemic, compared to the expected numbers of deaths informed by previous years’ cremation data. The causes of these excess deaths include infection with SARS-CoV-2, as well as causes likely related to the pandemic but not due to COVID-19 itself.
| May 12, 2021
Identifying Gaps in COVID-19 Health Equity Data Reporting in Canada Using a Scorecard Approach
| May 12, 2021
Characteristics and Outcomes of Hospital Admissions for COVID-19 and Influenza in the Toronto Area
| May 12, 2021
Canadian Federal-Provincial/Territorial Funding of Universal Health Care: Fraught History, Uncertain Future
| May 11, 2021
Risk of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) following the AstraZeneca/COVISHIELD Adenovirus Vector COVID-19 Vaccines
Published estimates of the risk of vaccine-induced thrombotic thrombocytopenia (VITT) from countries with moderate to high data quality range from 1 case per 26,500 doses to 1 case per 127,300 doses of AstraZeneca/COVISHIELD administered (Table 1).
The risk of VITT in Canada as of April 28, 2021 has been estimated to be approximately 1 per 100,000 doses, but several possible cases are still under investigation.
| May 7, 2021
Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) Following Adenovirus Vector COVID-19 Vaccination
This Science Brief provides information for health care professionals about Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT), also known as Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) and Thrombotic Thrombocytopenia Syndrome (TTS). This is a rare adverse event following adenovirus vector COVID-19 vaccines, including the AstraZeneca/COVISHIELD and Janssen/Johnson & Johnson COVID-19 vaccines.
This brief describes the pathophysiology, presentation, diagnostic work-up and treatment of VITT.
| May 6, 2021
Remdesivir for Hospitalized Patients with COVID-19
Remdesivir, a direct-acting antiviral agent, may reduce mortality and progression to mechanical ventilation in moderately ill patients hospitalized with COVID-19 on supplemental low-flow oxygen. The benefits of remdesivir for critically ill patients requiring supplemental oxygen via high-flow nasal cannula or mask, or non-invasive mechanical ventilation, is uncertain. Remdesivir does not benefit and may harm critically ill patients already receiving mechanical ventilation or requiring extra-corporeal membrane oxygenation (ECMO), and it does not provide substantial benefit for hospitalized patients who do not require supplemental oxygen. Remdesivir appears to have comparable effects when used for 5 days or 10 days, and does not appear to be associated with significant adverse effects.
Remdesivir is recommended in moderately ill hospitalized patients with COVID-19 requiring supplemental oxygen (Figure 1). Remdesivir may be considered for patients requiring oxygen supplementation via high-flow nasal cannula or mask, or non-invasive mechanical ventilation. It should not be used in critically ill patients on mechanical ventilation or those receiving ECMO. Remdesivir should not be used in patients who do not require supplemental oxygen.