Update on COVID-19 – April 15, 2021

Posted Thursday April 15, 2021

Posted By: Emily Ngo

Category: General

To: Ottawa Physicians, NPs, Midwives, Travel, and Walk-in Clinics
Date: April 15, 2021
From: Dr. Trevor Arnason, Associate Medical Officer of Health (AMOH), COVID-19 Vaccine, Ottawa Public Health, Dr. Robin Taylor, AMOH, Physician Engagement, Ottawa Public Health

Dear Colleagues,

Today’s Public Health Alert contains an eclectic mix of COVID information – please scan the headers to see if anything is applicable to your medical practice.

Access to COVID-19 Advice through eConsult

Rapid consults on a variety of COVID-19 topics are available through the Ontario eConsult Service, which allows physicians and nurse practitioners timely access to specialist advice. Specialist consults include:

  • COVID-19 Infectious Diseases
  • COVID-19 Vaccine - Public Health
  • COVID-19 Vaccine - Allergy/Immunology
  • COVID-19 and Autoimmune Disorders
  • COVID-19 and Pregnancy

eConsult for COVID-19 Vaccine Allergy Advice

Vaccine allergy questions best suited for eConsult include:

  • Patient eligibility for COVID-19 vaccine:
    • in relation to a patient’s allergic history
    • for patients who previously reacted to another vaccination (e.g. influenza vaccine)
    • for patients with an antibiotic, drug, food or stinging insect allergy
    • for patients with a history of reacting to radiocontrast media
  • Managing vaccination for patients with “mast cell activation disorder”
  • Premedication advice for patients with underlying chronic urticaria/angioedema

Requests for Fitness Center Accommodation

You may have heard about the accommodation in the Provincial stay-at-home Order that allows people with medical needs to access pools and other fitness centers during lockdown for physical therapy reasons. This provision allows for patients with medical needs to get the treatment they require. We encourage physicians and nurse practitioners who receive these requests to review the provincial guidance, which states that access to these facilities must be both medically necessary, and the physical therapy not available elsewhere.

Ottawa Public Health is aware that Ottawa Bylaw is monitoring and investigating all gyms that are currently open.

Questions from Patients about the COVID-19 Vaccine when Breastfeeding or while Pregnant

As more Ottawans become eligible to receive COVID-19 vaccine, requests to discuss receiving the vaccine while pregnant or breastfeeding may increase. The provincial guidelines require individuals who are pregnant to discuss evidence of risks/benefits with their physician before getting the vaccine. Breastfeeding patients may also seek advice from their physician or NP before receiving the vaccine.

For breastfeeding patients, the latest guidance from the Ministry of Health states “For any individuals who are breastfeeding, the COVID-19 vaccine should be offered after recognizing the insufficiency of evidence for the use of COVID-19 vaccine in the breastfeeding population.”

The Society of Obstetricians and Gynaecologists of Canada’s consensus statement on COVID-19 vaccination in pregnancy speaks to both pregnancy and breastfeeding:

  • Women who are pregnant or breastfeeding should be offered vaccination at any time during pregnancy if they are eligible and no contraindications exist.
  • This decision is based on the women’s personal values and an understanding that the risk of infection and/or morbidity from COVID-19 outweighs the theorized and undescribed risk of being vaccinated during pregnancy or while breastfeeding. Women should not be precluded from vaccination based on pregnancy status or breastfeeding.

Second dose timing of COVID-19 vaccine

The most recent statement from the National Advisory Committee on Immunization recommends extending the second dose of the COVID-19 vaccine up to four months after the first. This recommendation is made in the context of limited vaccine supply in the pandemic. Ontario has adopted this recommendation, and information of the second dose from the Ministry of Health can be found here.

NACI goes on to state that “second doses should be offered as soon as possible after all eligible populations have been offered first doses, with priority given to those at highest risk of severe illness and death from COVID-19 disease. Vaccinated people (with one or two doses) should continue to follow recommended public health measures. NACI will continue to monitor the evidence on effectiveness of an extended dose interval and will adjust recommendations as needed.”

Ottawa Public Health is required to follow the provincial guidelines for dosing intervals which includes a very limited number of medical exceptions such as organ transplant recipients and those receiving active cancer treatment. We are working with the Ottawa Hospital to identify these individuals. Letters from healthcare providers about a patient’s health conditions cannot over-ride the provincial dosing intervals.

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